Metal-Specific Biomaterial Accumulation in Human Peri-Implant Bone and Bone Marrow.

Janosch Schoon,Katrin Huesker,Melanie J Ort,Marine Cotte,Remi Tucoulou,Uwe Marx,Sven Geissler,Simon Reinke,Annika Winter,Georg N Duda,Dorit Jacobi,Adrien Lagrange,Anastasia Rakow,Carsten Perka,Bernhard Hesse

doi:10.1002/advs.202000412

Abstract

Metallic implants are frequently used in medicine to support and replace degenerated tissues. Implant loosening due to particle exposure remains a major cause for revision arthroplasty. The exact role of metal debris in sterile peri‐implant inflammation is controversial, as it remains unclear whether and how metals chemically alter and potentially accumulate behind an insulating peri‐implant membrane, in the adjacent bone and bone marrow (BM). An intensively focused and bright synchrotron X‐ray beam allows for spatially resolving the multi‐elemental composition of peri‐implant tissues from patients undergoing revision surgery. In peri‐implant BM, particulate cobalt (Co) is exclusively co‐localized with chromium (Cr), non‐particulate Cr accumulates in the BM matrix. Particles consisting of Co and Cr contain less Co than bulk alloy, which indicates a pronounced dissolution capacity. Particulate titanium (Ti) is abundant in the BM and analyzed Ti nanoparticles predominantly consist of titanium dioxide in the anatase crystal phase. Co and Cr but not Ti integrate into peri‐implant bone trabeculae. The characteristic of Cr to accumulate in the intertrabecular matrix and trabecular bone is reproducible in a human 3D in vitro model. This study illustrates the importance of updating the view on long‐term consequences of biomaterial usage and reveals toxicokinetics within highly sensitive organs.

Highlights

Modern arthroplasty implants enable painless mobility and ensure significant improvement of life quality
In order to perform spatially resolved multi-metal exposure assessment, 10 μm sections of peri-implant cancellous bone including intertrabecular bone marrow (BM) from 14 patients with different loosened knee and hip implants were analyzed by synchrotron micro- and nano-X-ray fluorescence (XRF) imaging
For orientation during XRF-mapping and for the definition of regions of interest (ROI), hematoxylin and eosin (H&E) stainings were performed on the sections adjacent to the sections used for XRF-scans (Figure 1B)

Summary

Introduction

Modern arthroplasty implants enable painless mobility and ensure significant improvement of life quality. A stable integration of the artificial joint in the peri-implant mineralized tissue is crucial for its success. Materials used in arthroplasty are of multi-elemental composition to ensure long-term mechanical stability of the implant.[1] Cobalt–chromium– molybdenum (CoCrMo) alloys, aluminum (Al) based ceramics and polyethylene are widely used for articulating components of total knee arthroplasty (TKA) and total hip arthroplasty (THA) implants. Titanium (Ti) alloys, such as titanium-aluminumvanadium (TiAlV), are most often used as base materials for load-bearing and stabilizing implant components.[2] In revision arthroplasty, the elemental diversity is even more pronounced due to additional stabilizing components such as porous tantalum (Ta), which can compensate for insufficient bone integrity.

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